Ann Dermatol.  2011 Nov;23(4):501-503.

Nicolau Syndrome in Patient Following Diclofenac Administration: A Case Report

• Kim KK

Abstract

Nicolau syndrome is a rare adverse reaction to a variety of intra-muscular drug preparations. The typical presentation is pain around the injection site soon after injection, followed by erythema, livedoid patch, hemorrhagic patch, and finally, necrosis of skin, subcutaneous fat, and muscle tissue. The phenomenon has been related to the administration of a variety of drugs, including non-steroidal anti-inflammatory drugs, corticosteroids, and penicillin. We report a case with typical features associated with diclofenac injection for pain control in a patient who had undergone bilateral total knee arthroplasty.

Keyword

Diclofenac; Nicolau syndrome; Total knee arthroplasty

MeSH Terms

Adrenal Cortex Hormones
Arthroplasty
Diclofenac
Drug Compounding
Erythema
Humans
Knee
Muscles
Necrosis
Penicillins
Skin
Subcutaneous Fat
Adrenal Cortex Hormones
Diclofenac
Penicillins

Figure

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  Fig. 1 Photography of right gluteal lesion three weeks post injection illustrating the nature and extent of the eschar.

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  Fig. 2 Post gadolinium enhanced computed tomography (CT) scan. The CT scan image showed an enhanced subcutaneous infiltration in the right buttock. There was no evidence of underlying muscle involvement, hematoma, or acute bleeding.

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  Fig. 3 Two months later, the defect appeared completely healed, with a small depressed scar.

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